Resuscitation and artificial respiration apparatus



March 8, 1932. R B SWOPE ET AL 1,848,232

RESUSCITATION AND ARTIFICIAL RESPIRATION APPARATUS Filed "Se t. 29.

1927 2 Sheets-Sheet arch 1932. R. B. swoPE ET AL RESUSCITATION AND ARTIFICIAL RESPIRATION APPARATUS Filed Sept. 29. 1927 2 Sheets-Sheet 2 attozweq A! .III "a M.

Patented Mar. 8, 1932 UNITED STATES PATENT OFFICE ROBERT B. SWOPE AND JOSEPH KB-EISELHAH, OF WASHINGTON, DISTRICT GOI-UIBIA.

BESUSGITATION AND ARTIFICIAL BESP'BATION APPARATUS Application fled September 29, 1827. Serial No. 222,867.

This invention relates to apparatus for resuscitation and producing artificial resplration, and relates particularlyto the type of apparatus by means of which a gas, generally oxygen, may be caused to fiow in controlled amounts and at controlled pressures from a source of supply to the lungs of a patient.

The problem of reviving drowned or asphyxiated persons and causing incipient respiration in infants is an old one, and numerous forms of respiratory apparatus have heretofore been produced for the solution of this problem. But from long experience with many of these devices it has been found that for one reason or another they are all open to serious objections. The tissues and membranes of the lungs are very fragile and the greatest skill is required on the part of the person administering gas by any present known form of apparatus to avoid bursting them, an event which practically always results in the death of the patient.

The principal object of the present invention, therefore, is the provision of apparatus for resuscitation or for producing artificial respiration, which may be operated in an effective manner by anyone and which in all cases may be operated with the utmost assurance that no matter how unskillful the operator, there will neverbe any danger that the patient will have his lungs ruptured or be otherwise injured through any fault or failure of the apparatus itself.-

Another object is the provision of such apparatus which is simple in all its parts and hence cheap to manufacture and easy to assemble, operate andrepair.

Another object is the provision of such apparatus comprising means for instantaneously relieving gas above a determined maximum pressure and for simultaneously and continuously indicating the normal prevailing pressure of the gas as it is supplied to the patient.

\Another object is the provision of an improved valve for controlling the flow of gas. Another object is the provision of an improved form of mask and airway for delivering the gas to the lungs of the patient.

Further objects and certain features 'of novelty of the invention will be ap arent to those skilled in the art from the ollowing description, taken in connection with the accompany ng drawings forming a part of this specification, and in which:

Figure 1 is a view of the assembled apparatus showing the method of its employment;

Figure 2 is a vertical sectional, view of one of the pressure reducing devices employed in connection with this invention;

Figure 3 is a central vertical section through the control valve employed;

Figure 4 is a sectional view of our improved type of mask;

Figure 5 is an enlarged vertical section through the manometric pressure relieving ang indicating device shown in Figure 1; an

Figures 6 to 8 are diagrammatic views to illustrate the use of the pressure relieving 7 and indicating device.

Referring more particularly to the drawings, wherein like reference characters are applied to like parts throu bout the several views, A denotes a gas ta or reservoir of 15 the usual and well-known type connected by a conduit generally designated by the letter B to a face mask C shown in Figure 1 in its correct operating position upon the patients head. Between the cylinder A and the mask 0 there are arranged along the tube B several devices for controlling the flow of the gas.

Some of these devices will be described separately and more in detail hereinafter, but for the present the may be sufiiciently identified in the order of their position along the conduit from the tank toward the mask as a cutofi valve D, a high pressure reducing device E, a low pressure reducing device F, and a control valve G. Also a pressure indicating no i and relieving device H is connected by a tube K to the conduit B beyond the control valve G and as near the mask C as practicable, while a time indicating device M, for example a metronome, is provided to guide the operator 05 in certain cases in the actuation of the valve G or, if desired, to govern the movements of the valve directly.

The conduit B then may be stiid to consist of several sections comprising: section 10 between the cylinder A and the valve D, the section 11 between the valve D and the high pressure reducing device E, the section 12 between the high pressure reducing device E and the low pressure reducing device F, the section 13 between the low pressure reducing device F and the control valve G, and the section 15 between the control valve G and the mask C. The cut-off valve D is controlled by a hand wheel 17 secured upon the stem 17 of the valve.

The high pressure reducing device E is of the usual form and includes an inlet pressure gauge 18 and an outlet pressure gauge 19.

The low pressure reducin device employed may be one of many wellnown types, but preferably the reducing device which we employ is constructed as shown in detail 1n Figure 2. It comprises a lower shell 20 and an upper shell 21 between which a diaphragm 22 of leather or similar flexible material is clamped by bolts 23. The upper shell 21 is extended centrally to form a hollow cap 24. The interior of this cap is threaded to receive an adjusting nut 25 bearing upon the upper end of a spring 26. The lower end of the spring rests on a metal plate carried by the upper side of the diaphragm 22 and the pressure at which the diaphragm operates to open and close the valve of the device is regulated by turning the nut 25. A cover 27 is secured upon the cap 24 above the nut to protect the same from unauthorized or accidental adjustments. The lower shell 20 is provided with an inlet port 28 and an outlet port 29, the inlet port 28 preferably being made through a bushing 28 providing a seat 28 for a valve plug 30. The other end of the valve plug 30 is bifurcated and carries a pin 31 across the slit thus formed.

The valve plug 30 is operated by a bell crank lever 32 which is provided with a disc or ball end 32 comprising one arm of the bell crank and a lever 32 comprising the other arm of the bell crank. A pin 33 passing through the bell crank lever 32 near the juncture of its arms and through a bracket 34 car ried by the bushing 28 serves as a pivot for the movement of the lever. A link 35 connected to a plate 36 secured to the diaphragm 22 at one end and to the outer end of the lever 32 at its other end by pins-37 and 38 respectively serves as an operative connection between the diaphragm and the bell crank lever operating the valve plug. From this arrangement, it is seen that the valve plug 30 will be moved in accordance with movements of the diaphragm 22 which in turn is controlled in its movement by the pressure of the gas within the lower shell 20, that is, the valve is closed in response to the pressure of the outflowing gas since an excessive pressure existing in the chamber beneath the diaphragm will serve to close the valve plug 30 against its seat. Preferably the casing of the device is made of aluminum or some light metal, since in ractice it must be made quite large to provi e the degree of sensitiveness desired.

The hand valve is shown in detail in Figure 3. It comprises. a valve body 40 axially apertured at 40 and having an inlet port 41, an outlet port 42 and a combined inlet and outlet port 43. Each of these ports has an associated nipple by means of which tubes may be attached. The lower end of the valve aperture is closed by aplug 44 and intermediate its ends this aperture changes diameter to provide an annular seat 45 for a valve member 46 mounted on spindle 47. The upper end of the spindle pro ects through a perforated spider 48 to the exterior of the valve body, being slidably supported centrally of the aperture 40 by the spider, and its cylindrical lower end is adapted to extend within a cylindrical recess 49 in plug 44 when the valve is opened, and to be uided thereby. A spring confined between p ug 44 and valve 46 normally maintains the valve seated. Upon the upper end of the valve spindle is mounted a second-valve member 50 which is adapted to seat upon the top of the valve body, thus closing the upper end of aperture 40.

WVhen the valve spindle is lowered by means of the hand lever 51 all three ports 41, 42 and 43 are brought into communication and the opening to the atmosphere is blocked by valve member 50. Oxygen may therefore flow to the mask G and to the safety device H. When valve 46 is closed the oxygen supply is interrupted but both ports 42 and 43 are brought into communication with the atmosphere. In this position of the valve the patient may exhale and the liquid columns of the safety device return to zero position. Tube 15, connecting the hand valve and face mask C, is preferably short in length and relatively large in diameter so that the gases may freely pass therethrough in both directions and so that there may be no stagnant gases passing back and forth in this tube.

The mask C is shown most clearly in Figure 4 where it may be seen to comprise a shield 60 adapted to fit over the mouth, nose and chin of the patient. This shield is generally funnel-shaped and at its smaller end is provided with an aperture 61. The entire larger end of the shield is lined on the edges by a soft rubber or inflatable rubber pad 63 for sealing the space between the face of the patient and the shield. A nipple 64 is provided with a reduced portion 65 extending through the aperture 61 of the shield and is threaded to receive a nut '66 which serves to clamp the shield against a shoulder :formed at the end of the reduced portion' 65. A further reduced portion 67 is formed on the nipple within the shield 60'and upon this por- L? tion 67 a catheter or throat tube 68 of stifily flexible material is secured.

This tube hasa suitable port 69 in its extreme end, either axially disposed or laterally, as shown in the drawings. The face piece or mask provides a clear unobstructed passage for the gas from the machine to the lungsof the patient without change in the pressure of the gas. Simply placing the mask over the face with the airway over the tongue provides this free passage, which is absolutely essential in resuscitation of an asphyxia-ted newly born baby, for instance, whose tissues are relaxed. If this airway were not used, the results sought by the use of the entire apparatus would be largely defeated because the relaxed tongue would be pushed into the throat, and in such case, if suiiicient pressure were employed to force oxygen past this obstruction at all times, there would be great danger of suddenly filling the lungs with gas under such pressure that the lungs would be ruptured. With the improved face piece, however, it is entirely possible to use an entirely safe and non-fluctuating pressure. This also holds true in the 7 resuscitation of other unconscious patients.

Although two pressure reducing devices have been employed in order to safeguard the patient, it is desirable to have further assurance that the patient will not be injured by excessive pressure under any conditions whatsoever. To this end the pressure relieving device H is employed in connection with the other elements of the combination. This device is intended not only to relieve excessive ressure of the gas. but also to give a constant indication which may be readily read showing exactly at what pressure gas is being supplied to the patient. In the preferred form of this device illustrated in the drawings, a plurality of upstanding tubes 70, 71,

72 are connected to a base 7 3 and have intercommunication therethrough by way of the passage or bore 74, as clearly shown in Figure 5. One of these tubes, for example the central one 71, is connected by the tube K to the conduit B bymeans of the port 42 of valve G. The connection of the tube K with the conduit .15 is arranged as near the mask C as conveniently possible. In all cases, the

connection is made between the mask and the valve member 46. Thus pressure of the gas existing in the conduit B beyond the valve G is permitted to have access to the upper end of the tube 71. The pressure-relieving device in its preferred form is of the mano metric type and is supplied with a liquid, preferably a light liquid such as water, until it rises to the desired height in all three tubes. A valve 7 is provided at the upper end of the tube 71 for relieving any vapor pressure existing in that tube to the atmosphere, in order to insure that the liquid in initial position stands at a uniform level in the three tubes. The tube is secured at its upper end in a sleeve of an extension cap 76 attached to the tube 71 by a packing gland 77. The tube is sealed to the base 73 by another packing gland 78. The tube 72 is provided at or near its upper end with a reservoir 79. This reservoir in the preferred form comprises a greatly enlarged cup which. is mounted-on a hollow stem slidable within the tube 72. A packing gland 81, threaded on the tube 72, provides a water-tight joint between the tube 72 and the hollow stem 80.

A marker is slidably mounted on one of the tubes, preferably 71, to indicate the height of liquid therein. This marker comprises a metallic frame having a bottom pointer 86 which initially is adjusted to the original or zero level of the liquid, that is, the level at which the liquid stands when at the same height in all three tubes, a second pointer 87 positioned at a set distance above the zero point 86 and may, for example, indicate the height, to which liquid will rise in the tube 70 at the desired pressure for infants, while a third pointer 88 at a fixed distance above the pointer 87 may indicate the allowable pressure for adults. The marker may conveniently be clamped in any set position by bolts89 passing through the split collars 90 thereon. From this description it will be seen that the marker 85 is positioned after the tubes have been supplied with the body of liquid so that the zero pointer coincides with the upper level of the liquid. Opposite the pointers 86, 87, 88 corresponding pointers 92, 93, 94 are placed adjacent the tube 72. The cup 79 is provided with a mark to be positioned adjacent one of the pointers 93 or 94 when the liquid stands at the zero pointer in the tubes. As shown the annular upper edge 95 of a flange on the cup serves as the adjusting mark thereon.

The operation of the apparatus will be understood from the above disclosure and the diagrammatic illustration of Figures 6 to 8. The parts are assembled as shown in Figure 1 with the tank A filled with the gas to be inj ected and the valve Dopening communication between the same and the conduit B. The mask C is not as yet in place on the face of the patient. The relief. valve 75 at the upper end of tube 71 is opened and liquid is poured into the cup 79 until it stands'at the desired uniform height in all three tubes. The marker 85 is loosened and moved along the tube 71 until thepointer 86 is even with the upper surface of liquid in the tube 70, the cup 7 9 at the same time being moved until the upper edge 95 of its base flange coincides with a selected one of the pointers 93 or 94. The marker is then clamped in position. This position of parts is shown in Figure 6, the cup being set at the height of the pointer 93 so the apparatus may be used for infants.

The valve 75 is closed and the conduit B is v pinched shut along the section 15, while the hand valve lever 51 is squeezed to move the valve to its upper scat. Gas from the tank A passing through the conduit B and tube K will press upon the top surface of the liquid in tube 71 and cause itto move from that tube toward the two side tubes 7 O and 72. If the pressure is great enough it will cause some of the gas to bubble out of tube 72 and cup 79. While gas is thus free to pass to the tube 71 the adjusting nut 25 in thepressure reducing device F is turned until the pressure of gas reaching the tube 71 is such that the liquid in tubes 70 and" 72 stands at the pointers 87 and 93 and a very small portion of gas bubbles out through tube 72. The apparatus at this stage after release of the Va Ve handle and conduit section 15 is conditioned for immediate use upon infants.

The mask is applied to the face of a patient as shown in Figure 1, the catheter airway tube being over the tongue and projected into the pharynx. A slight pressure will hold the pad 63 firmly against the patients face and the catheter tube in correct position. For newborn infants a single injection of gas (oxygen) is usually sufficient to supply the required initial inflation of the lungs and start them breathing so in this case the valve handle need only be pressed down once and held down for the required period. It may, however, be necessary to supply a number of forced inhalations to start natural breathing and in order to time the operation of the valve to correspond with the natural period of breathing the operator will press the valve handle 51 in timed response to. his own breathing or alternatively start the metronome M and press the handle in timed response to the beats of that time indicator. As soon as the valve member 46 is moved from its seat gas will flow from the inlet I port 41 through aperture 40a and port 43 to the lungs of the patient. Some gas will escape around the valve member 50 to the at mosphere through apertures in the spider 48 but as the valve member 50 requires only a short period of time to pass to its seat the amount of gas lost in this manner will be negligible. This stage of conditions is represented in Figure 7 where it is seen that the liquid has not been driven completely from the central tube 71 and does not rise quite to the pointer infants in the outer tubes.

When the handle is released the valve member 50 leaves its seat and immediately both ure or sticking of valves E or F it will pass through tube K and escape by bubblin outof cup 79 as clearly shown in Figure 8.

ere it is seen that all the li uid has been expelled from the lower end of tube 71 and has divided into two bodies in the channel 74, one toward tube and the other toward tube 7 2. After division little liquid will be forced u tube 70 due to the fact that the tube is sma l and the level is quickly raised; but on the other hand, the body dividing toward tube 72 will quickly be forced so far in that direction that as'can reach the lower end of the tube and ubble out due to the fact that a large volume of the liquid can be forced up the tube and into the cup 79 without appreciably raising the liquid level therein.

When the excess pressure condition is relieved all of the liquid is immediately available as before, since none of it has been forced out of the system, the cup returning all that it, received in the original amount. The operator is thus permitted to continue his efforts at resuscitation in spiteof the excess pressure condition without danger of supplying gas at a dangerous pressure to the patient and without interruption due to loss of the body of liquid in the pressure indicating and relieving device.

It will be evident from the above disclosure that various departures may be made from the embodiment particularly described without departing from the spirit of the invention and the applicant does not desire the invention to be re arded as limited except by the prior art an the appended claims.

Having thus described the invention, what is claimed as new and desired to be secured by Letters Patent is:

1. Apparatus for producing artificial respiration, in combination, a source of as under pressure, a face mask, a conduit be tween said source and said mask, a pressure reducer in said conduit, a valve permitting the flow of gas to said mask or permitting reverse flow of exhaled gas from said mask to atmosphere, a liquid-seal pressure-relieving device connected to said conduit at a point near said mask, said device comprising three upstanding tubes having communication at their lower ends, one of said tubes receiving gas from said conduit at its upper end upon the surface of the liquid therein, another of said tubes receiving a quiet column of liquid and having means therealong to give an indication of pressure, and the third one of said tubes havingan enlarged reservoir at its upper end for receiving excess liquid when the gas pressure rises above a determined amount and permitting excess gas to discharge therethrough to the atmos phere.

2. Apparatus for producing artificial respiration, in combination, a source of gas under pressure, a face mask, a conduit between said source and said mask, a pressure regulating device in said conduit including means for adjusting the outlet pressure of said device, a valve permitting the flow of gas to said mask or permitting reverse flow of exhaled gas from said mask to atmosphere, and a manometer connected to the conduit at a point near said mask, one of the tubes of said manometer having anadjustable reservoir fitted thereto, said reservoir being arranged to be set in adjusted positions in accordance with the maximum gas pressure settings of said device and permitting escape of excess gas therethrough without loss of the liquid column ofsaid manometer.

3; Apparatus for producing artificial respiratlon, in combination, a source of gas under pressure, a pressure reducin device, a face mask, a conduit between said device and said mask, a valve in said conduit near said mask for alternately supplying gas to said mask and for closing the conduit while permitting reverse flow of exhaled gas from said mask to atmosphere, and a pressure-relieving device connected to said conduit, said device comprising three tubes having communication at their lower ends, one of said tubes receiving gas under pressure upon the upper surface of a liquid column contained therein, a second one of said tubes having a reservoir adjustable along its axis for receiving a portion of the liquid forced from the first mentioned tube and permitting excess gas to escape therethrough, and a third one of said tubes receiving a portion of the liquid forced from the first mentioned tube and maintaining the same in a quiet state, there being a scale provided adjacent the third mentioned tube for determining at any instant the pressure of the gas in the device.

4. Apparatus for producing artificial respiration by introducing into the lungs of a patient a gas under such pressure as to inflate the lungs without causing rupture or injury to the walls thereof, and thereafter permitting expiration of such gas by the natural contraction of the chest structure, ineluding in combination, means for supplying gas under pressure greater than that to which a patients lungs may be subjected, an appliance to be fitted to the patients head and by means of which gas may be introduced into the patients lungs without substantial leakageto the atmosphere, a conduit connecting the said appliance and the source of gas supply, means positioned in said conduit for reducing the pressure of the gas passing from the source of supply to said appliance, a device also associated with said conduit for preventing the pressure of gas therein between the said pressure reducing means and the said appliance from exceeding a predetermined maximum, said device comprising a liquid seal having a water column open at its $5 top and provided with a container within which the water discharged by escaping as is caught and from which container the uid is discharged by gravity into the water column to re-establish the seal when the pressure has again become normal, and a valve in said conduit between the appliance and the pressure reducing device to at times shut off the supply of gas and open the appliance to atmosphere for exhalation.

5. Apparatus for producing artificial respiration by introducing into the lungs of a patient a gas under such pressure as to inflate the lungs without causing rupture or injury to the walls thereof and thereafter permitting expiration of such gas by the natural contraction of the chest structure, including in combination, means for supplying gas under pressure greater than that to which a patients lungs may be safely subjected, an appliance to be fitted to the patients head and by means of which gas may be introduced into the patients lungs without substantial leakage to the atmosphere, a conduit connecting the said appliance and the source of gas supply, means positioned in said conduit for reducing the pressure of gas passing from the source of supply to said appliance, a two-way valve positioned to control the flow of gas from said pressure reducing means to said appliance, which in one position of adjustment establishes communication between the source of supply and the appliance and which in another position of adjustment establishes communication between the appliance and the atmosphere, and a device also associated 100 with said conduit for preventing the pressure of gas therein between the said pressure re ducing means and the said appliance from exceeding a predetermined maximum, said valve establishing communication between 105 said pressure relieving device and the source of supply only when the appliance is connected to the source of supply.

6. Apparatus for producing artificial respiration by introducing into the lungs of a no patient a gas under such pressure as to inflate the lungs without causing rupture or injury to the walls thereof, and thereafter permitting expiration of such gas by the natural contraction of the chest structure, including, 115 in combination, means for supplying gas under pressure greater than that to which a patients lungs may be subjected, an appliance to be fitted to the patients head and by means of which gas may be introduced into 120 the patients lungs without substantial leakage to the atmosphere, a conduit connecting the said appliance and the source of gas supply, means positioned in saidconduit for reducing the pressure of the gas passing from 125 the source of said appliance to a suitable pressure for administration, a device for preventing the pressure of gas in said conduit adjacent said appliance from exceeding a predetermined maximum, said device also con; 13c

stituting an indicator of the true pressure of the gas passing to said appliance, and a valve device in said conduit having means to shut off the flow of gas to said appliance and said 5 pressure indicating device and open them to atmosphere and having means whereby said parts may be connected to the source of gas and shut off from atmosphere.

In testimony whereof we hereunto aflix our signatures.

JOSEPH KREISELMAN. R. B. SWOPE. 

